1952675035 NPI number — NANCY LIU MATSUURA PHARMD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952675035 NPI number — NANCY LIU MATSUURA PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATSUURA
Provider First Name:
NANCY
Provider Middle Name:
LIU
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LIU
Provider Other First Name:
NANCY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1952675035
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2310 LONGFIBRE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UNION GAP
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98903-1513
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-454-5249
Provider Business Mailing Address Fax Number:
509-454-5246

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2310 LONGFIBRE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNION GAP
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98903-1513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-454-5249
Provider Business Practice Location Address Fax Number:
509-454-5246
Provider Enumeration Date:
03/07/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  PH00045509 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PH00045509 . This is a "STATE PHARMACIST LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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